Monday, October 1, 2012

Bipolar vs. Borderline?

One of the joys of my job is that I diagnosis clients with mental illness, I find it necessary for someone to have the right diagnosis in order to move forward with treatment. I often explain Mental Health diagnosis's as looking like a Venn Diagram with much overlap and often very little differentiation.

The tricky part is the past diagnosis's the clients have had. There have been multiple clients that when I asked for current diagnosis they listed 5 contradicting diagnosis and the more I probed and speak with them the more it looked like 1 or 2 total. This all brings me to a point regarding Bipolar Borderline. Most of the women that I have meet whom are diagnosed as Bipolar are not. When I ask for mania symptoms they tell me things such as "I yell at my teenage son," "I blow up at my husband," "I get so angry I...." or "Sometimes I just don't want to talk to people and hide." All of these are normal reactions for people with little/no coping skills. I don't know anyone (even without a mental health diagnosis) whom wouldn't have at some point said yes to all 4. I think this over diagnosis happens for a few reasons:

Women are not suppose to get angry

Anger in women sometimes feels like anxiety and a loss of control

Psychiatrists don't know what Bipolar really is diagnostically

Mood swings are viewed as "rapid cycling"

It's easier to medicate a disorder than help someone with coping skills

For these reasons I take a lot of time and consideration into diagnosing women with Bipolar, especially those with trauma and abuse in their history. Many of these women more likely have Borderline Personality Disorder (I am unable to "officially" diagnosis Axis II because of other reasons) and Post Traumatic Stress Disorder. Here are the difference between Bipolar and Borderline Personality Disorder (via Psychology Today article )

1. People with BPD cycle much more quickly, often several times a day.

2. The moods in people with BPD are more dependent, either positively or negatively, on what's going on in their life at the moment. Anything that might smack of abandonment (however far fetched) is a major trigger.

3. In people with BPD, the mood swings are more distinct. Marsha M. Linehan, professor of psychology at the University of Washington, says that while people with bipolar disorder swing between all-¬encompassing periods of mania and major depression, the mood swings typical in BPD are more specific. She says, "You have fear going up and down, sadness going up and down, anger up and down, disgust up and down, and love up and down."